Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, June 05, 2007

Protecting our Children

Re my most recent post on the Thimerosal hoax, Mr. Gunn asks about the epidemiology of vaccine refusal. I can't find any numbers on how many families refuse vaccination nationwide, but there was a survey of pediatricians done a couple of years ago, which WaPo's Sandra Boodman discussed here. More than half said they'd encountered at least one family in the previous year who refused all vaccinations, and 85% said they'd encountered a family that refused at least one.

Now, that doesn't necessarily translate into a huge problem -- primary care physicians such as pediatricians typically have caseloads of around 1,500 or so (with a lot of variation). Because of herd immunity -- an unvaccinated child is unlikely to be exposed to a pathogen if most of the other children in the community are vaccinated -- we can tolerate a low rate of non-immunization. However, the situation certainly could become dangerous if a lot of families in a particular area opted out. And indeed, Boodman interviews a pediatrician who estimates that he and his partners in northern Virginia each confront vaccine refusers about twice a month. I don't have enough information to do the math, but if enough of those kids are attending the same school or day care center, it certainly could create a dangerous situation for them.

To me it is of equal concern that, as Boodman reports -- and this was a surprise to me as well as the investigators -- "More surprising to the authors were two findings: 39 percent of those surveyed said they would consider turning away a family that refused all shots -- researchers had expected the number to be about 20 percent -- while 28 percent said they'd think about severing a relationship with a family that refused some shots." My gut reaction is that this is not really ethical, and its certainly counterproductive. Doctors should counsel such families and provide them with truthful information and access to resources that will help them make an informed decision. But this is certainly an indication of how frustrating this whole sorry business is to doctors.

What is most frustrating to me, as a non-physician specialist in public health policy, is that the vaccine-autism hoax has become linked in some people's minds with progressive politics and consumer empowerment. For that, of course, we principally have RFK Jr. to blame, which is why I am so contemptuous of him. He has not only deceived and harmed the families who believe his lies, and their children, he has also undermined and discredited everyone who works to empower health care consumers and take back public health and health care from the control of corporate greed. It is just one more extraordinarily offensive consequence of our celebrity-driven media culture.